Provider Demographics
NPI:1316094063
Name:INTEGRATIVE MEDICAL CENTER OF TULSA, LLC
Entity type:Organization
Organization Name:INTEGRATIVE MEDICAL CENTER OF TULSA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-743-7097
Mailing Address - Street 1:3105 E SKELLY DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6358
Mailing Address - Country:US
Mailing Address - Phone:918-743-7097
Mailing Address - Fax:918-743-7097
Practice Address - Street 1:3105 E SKELLY DR
Practice Address - Street 2:SUITE 303
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6358
Practice Address - Country:US
Practice Address - Phone:918-281-6471
Practice Address - Fax:918-281-6480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22665207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty